Vitamin D and hematinic deficiencies in patients with recurrent aphthous stomatitis

  • Suhail H. Al-AmadEmail author
  • Hayder Hasan
Original Article



Recurrent aphthous stomatitis (RAS) represents a dysfunction in focal inflammatory processes. With the emerging anti-inflammatory roles of vitamin D (VD), we wanted to investigate the association between the onset and severity of RAS and serum VD level.


Fifty-two RAS cases and sex and age-matched controls were screened for serum iron, B12, folic acid, VD and red cell indices. Variables were compared using independent samples t test and chi square. Binary logistic regression was used to assess the association between the severity of RAS and various hematinic deficiencies.


VD was deficient in 53% of the study population with no statistically significant difference between the RAS patients and healthy controls (53.6 versus 51.5 nmol/l, respectively). In comparison with controls, RAS patients had lower means of iron (81.0 versus 89.3 μg/dl), vitamin B12 (368.5 versus 412.7 pg ml) and most of the red cell indices; however, these differences were not statistically significant. No correlations were seen between RAS severity assessed by ulcer diameter, number of ulcers and their frequency and hematinic deficiencies. However, logistic regression showed a significant association between the number of ulcers (single or multiple) and VD deficiency (OR 4.978; 95% CI 1.204–20.576; p value = 0.027), adjusted for age, sex and other hematinics.


VD deficiency appears to have a role in aggravating RAS ulcerative episodes, but not their onset.

Clinical Relevance

Multiple aphthous ulcers might represent a subcategory of RAS lesions in which VD deficiency plays a role in aggravating the oral ulcerative condition.


Oral ulcer Vitamin D Vitamin B12 Iron Anemia United Arab Emirates 



The authors thank Professor Manal Awad for her assistance in statistical analysis, Dr. Jihad Saadeh for his technical assistance in laboratory analysis and Dr. Manal Elbakai and Dr. Rand Rizq for their assistance in recruiting cases and controls.


This research was funded by the University of Sharjah Competitive Research Grant (no. 16011001020-P).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research was reviewed and approved by the University of Sharjah Research Ethics Committee (approval letter no. REC-16-09-24). The said committee works in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study. The Participant Information Sheet and the Informed Consent documents were reviewed and approved by the University of Sharjah Research Ethics Committee.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Oral and Craniofacial Health Sciences, College of Dental MedicineUniversity of SharjahSharjahUnited Arab Emirates
  2. 2.Consultant Oral MedicineUniversity Hospital SharjahSharjahUnited Arab Emirates
  3. 3.Department of Clinical Nutrition and Dietetics, College of Health SciencesUniversity of SharjahSharjahUnited Arab Emirates
  4. 4.Research Institute of Medical and Health SciencesUniversity of SharjahSharjahUnited Arab Emirates

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